Nursing Interventions for Critically Ill Traumatic Brain Injury Patients

Abstract

Neuroscience intensive care unit (ICU) nurses deliver a number of interventions when caring for critically ill traumatic brain injury (TBI) patients. Yet, there is little research evidence documenting specific nursing interventions performed. As part of a larger study investigating ICU nurse judgments about secondary brain injury, ICU nurses were asked to identify interventions routinely performed when caring for TBI patients. Quantitative and qualitative analyses indicate that all nurses routinely monitored hemodynamic parameters such as oxygen saturation, blood pressure, and temperature. Nurses were responsible for monitoring intracranial pressure and cerebral perfusion pressure approximately 50% of the time. Qualitative analyses revealed that additional nursing interventions could be categorized as neurophysiological interventions, psychosocial interventions, injury prevention interventions, and interventions to maintain a therapeutic milieu. Findings from this study provide evidence of the multifaceted role of the neuroscience ICU nurse caring for TBI patients and can be used in future research investigating the impact of nursing interventions on patient outcomes.

Effects of Nursing Interventions on Intracranial Pressure

“…These include talking with the patient, repositioning endotracheal tubes or cervical collars, draining cerebrospinal fluid (CSF), limiting environmental stimulation, raising the head of the bed, and administering medications. Despite research indicating that nurses routinely perform these and other psychosocial-related interventions among critically ill neurological patients, 4,22 no studies have explored the immediate effects of these interventions on ICP values. Data are needed to determine how these interventions affect ICP.…”

“…Although some interventions are specifically targeted to reduce ICP, a variety of interventions may directly or indirectly affect ICP. [4][5][6][7] The impact of these interventions has not been well described. A few select studies [8][9][10] have been done to investigate statistical correlations between a specific intervention and ICP values.…”

“…The nurse talking to the patient is clearly recognized as a nursing intervention. 4,27,28 In the ICU, the nurse is often the gatekeeper and therefore, it is reasonable to assume that the nurse facilitates and encourages patients' family members to interact with the patient. 22,29 Having family members talk to or around the neurologically impaired patient in our study was associated with an increased likelihood of decreasing ICP values at 1-and 5-minute intervals.…”

Significant Practice Pattern Variations Associated With Intracranial Pressure Monitoring

“…The site investigator at each institution positioned herself or himself such that they could observe all activities and vital signs within the patient's room. Site investigator training consisted of written instructions on the use of a standardized case report form (CRF) to record the ICP, heart rate, respiratory rate, blood pressure, temperature, and those nursing actions (Table 3) previously reported in the literature as being associated with ICP change (McNett & Gianakis, 2010;Mitchell & Mauss, 1978;Mitchell et al, 1981;Olson, Bader, Dennis, Mahanes, & Reimen, 2010). Observations were recorded once each minute during the 2-hour observational period.…”

Padrão de intervenções de enfermagem realizadas em vítimas de trauma segundo o Nursing Activities Score

“…In the neurological ICU, one of the main nursing interventions routinely performed on victims of head injuries was monitoring hemodynamic parameters, with control of intracranial pressure and brain perfusion requiring 50% of the time of such professionals (9) . The only study that used NAS for trauma victims hospitalized in the ICU used a sample of 32 patients, and found a large nursing workload on admission of the patient to the unit (mean NAS of 85.0%) and a high frequency (>90%) of interventions related to laboratory investigations, medication, measuring urinary output and support for the patient and his/her family (10) .…”